Patterns of preoperative laboratory testing in patients undergoing outpatient plastic surgery procedures

Aesthet Surg J. 2014 Jan 1;34(1):133-41. doi: 10.1177/1090820X13515880. Epub 2013 Dec 12.

Abstract

Background: Preoperative laboratory testing is commonplace in the clinical setting and is often utilized at surgeon discretion. We searched the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) data set to determine the impact of preoperative laboratory testing in ambulatory plastic surgery patients.

Objective: The authors assess the utilization and predictive value of preoperative laboratory testing in outpatient plastic surgery procedures.

Methods: Patients undergoing ambulatory plastic surgery were identified from the 2005 to 2010 NSQIP databases. Laboratory tests were categorized by group: hematologic, chemistry, coagulation, and liver function tests (LFT). We defined complications in 2 groups: major postoperative and wound complications. Multivariate analyses were used to identify patient characteristics associated with testing and to assess the ability of laboratory testing to predict postoperative complications.

Results: A total of 5359 (62.0%) patients underwent testing; 881 (16.4%) tests were performed on the day of surgery. In patients with no defined NSQIP comorbidities, 59.4% underwent preoperative testing and had a significantly lower rate of abnormal findings (33.4% vs 25.3%, P < .0001). In multivariate analyses, testing was associated with older age, American Society of Anesthesiologists class >2, Hispanic or African American race, body contouring procedures, epidural or spinal procedures, and with diabetes, hypertension, and cancer. Major complications occurred in 0.34% of patients. Our analysis demonstrated that neither testing nor abnormal results were associated with postoperative complications, either major (P = .178) or wound (P = .150).

Conclusions: We found no association between abnormal laboratory testing and postoperative morbidity. Preoperative testing in low-risk ambulatory plastic surgery patients may be costly and has limited direct clinical benefit.

Keywords: ambulatory surgery; complication; laboratory; labs; preoperative testing.

MeSH terms

  • Adult
  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / trends*
  • Blood Chemical Analysis / trends
  • Chi-Square Distribution
  • Clinical Laboratory Services / trends*
  • Comorbidity
  • Cosmetic Techniques / adverse effects
  • Cosmetic Techniques / trends*
  • Female
  • Hematologic Tests / trends
  • Humans
  • Liver Function Tests / trends
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Postoperative Complications / etiology
  • Practice Patterns, Physicians' / trends*
  • Predictive Value of Tests
  • Preoperative Care / trends
  • Reconstructive Surgical Procedures / adverse effects
  • Reconstructive Surgical Procedures / trends*
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States